Customer Service Representative II

Bilingual Mandarin/Cantonese

Job description:

You could be the one who changes everything for our 26 million members as a Customer Care professional. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner

• Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
• Provide assistance to members and/or providers regarding website registration and navigation
• Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
• Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
• Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
• Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
• Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
• Work with other departments on cross functional tasks and projects
• Maintain performance and quality standards based on established call center metrics including turn-around times

Education/Experience: High school diploma or equivalent. Six months experience as a Customer Service Representative or previous Call Center, Healthcare or insurance experience. Should be proficient in understanding the working of a call center environment. Skilled in customer service, verbal communication over the phone. Claims processing, billing and/or coding experience preferred.

What are the 3-4 non-negotiable requirements of this position?

Must be able to speak, translate and read fluently in Mandarin and Cantonese. Healthcare Medical terminology

What are the nice-to-have skills?

Call Center

Job Type: Full-time

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift

Experience:

• Customer service: 2 years (Preferred)

Language:

• Mandarin / Cantonese (Preferred)
• Chinese (Preferred)
• Bilingual (Preferred)

Work Location: Remote

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